Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED)
0.1.0 - ci-build

Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: MOPED Coverage

Official URL: https://elga.moped.at/StructureDefinition/MopedCoverage Version: 0.1.0
Draft as of 2025-06-26 Responsible: ELGA GmbH Computable Name: MopedCoverage

MOPED Profil der Coverage Ressource für Versicherungen.

Usages:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
.... identifier:VDASID SΣ 0..1 Identifier Business identifier(s) for this coverage
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:oid:1.2.40.0.10.1.4.3.9.1
..... assigner Σ 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... policyHolder Σ 0..1 Reference(HL7® AT Core Patient Profile | MOPED Hauptversicherter) Owner of the policy
... beneficiary Σ 1..1 Reference(HL7® AT Core Patient Profile) Plan beneficiary
... insurer Σ 0..1 Reference(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding
.... class:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc.
..... value Σ 1..1 Identifier Value associated with the type
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (required)
...... coding Σ 1..* Coding Code defined by a terminology system

Required Pattern: At least the following
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
..... value Σ 1..1 Identifier Value associated with the type
...... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
...... system Σ 0..1 uri The namespace for the identifier value
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.identifier:VDASID.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|5.0.0
From the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
From the FHIR Standard
Coverage.kindrequiredKind
http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0
From the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
From the FHIR Standard
Coverage.class:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
Coverage.class:Versichertenkategorien.value.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|5.0.0
From the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage Coverage
... Slices for identifier 0..* Identifier Business identifier(s) for this coverage
Slice: Unordered, Open by value:system
.... identifier:VDASID S 0..1 Identifier Business identifier(s) for this coverage
..... system 1..1 uri The namespace for the identifier value
Required Pattern: urn:oid:1.2.40.0.10.1.4.3.9.1
..... assigner 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... paymentBy
.... party 1..1 Reference(HL7® AT Core Organization Profile) Parties performing self-payment
... policyHolder 0..1 Reference(HL7® AT Core Patient Profile | MOPED Hauptversicherter) Owner of the policy
... insurer 0..1 Reference(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (required)
...... coding 1..* Coding Code defined by a terminology system
Required Pattern: At least the following
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
..... value
...... system 0..1 uri The namespace for the identifier value
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Coverage.class:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 0..* Identifier Business identifier(s) for this coverage
Slice: Unordered, Open by value:system
.... identifier:VDASID SΣ 0..1 Identifier Business identifier(s) for this coverage
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:oid:1.2.40.0.10.1.4.3.9.1
..... value ΣC 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... paymentBy 0..* BackboneElement Self-pay parties and responsibility
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... party Σ 1..1 Reference(HL7® AT Core Organization Profile) Parties performing self-payment
.... responsibility Σ 0..1 string Party's responsibility
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelfPayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
... policyHolder Σ 0..1 Reference(HL7® AT Core Patient Profile | MOPED Hauptversicherter) Owner of the policy
... subscriber Σ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
... subscriberId Σ 0..* Identifier ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(HL7® AT Core Patient Profile) Plan beneficiary
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... insurer Σ 0..1 Reference(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding
.... class:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc.
..... value Σ 1..1 Identifier Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (required)
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 1..* Coding Code defined by a terminology system

Required Pattern: At least the following
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... value Σ 1..1 Identifier Value associated with the type
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
...... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... system Σ 0..1 uri The namespace for the identifier value
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
...... value ΣC 0..1 string The value that is unique
Example General: 123456
...... period Σ 0..1 Period Time period when id is/was valid for use
...... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
..... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example)
.... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example)
.... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example)
.... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example)
.... value[x] Σ 0..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details
... insurancePlan 0..1 Reference(InsurancePlan) Insurance plan details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.languagerequiredAllLanguages
http://hl7.org/fhir/ValueSet/all-languages|5.0.0
From the FHIR Standard
Coverage.identifier:VDASID.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|5.0.0
From the FHIR Standard
Coverage.identifier:VDASID.typeextensibleIdentifierTypeCodes
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
From the FHIR Standard
Coverage.kindrequiredKind
http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0
From the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelfPayCodes
http://hl7.org/fhir/ValueSet/coverage-type
From the FHIR Standard
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
From the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
From the FHIR Standard
Coverage.class:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
Coverage.class:Versichertenkategorien.value.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|5.0.0
From the FHIR Standard
Coverage.class:Versichertenkategorien.value.typeextensibleIdentifierTypeCodes
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
From the FHIR Standard
Coverage.costToBeneficiary.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
From the FHIR Standard
Coverage.costToBeneficiary.networkexampleNetworkTypeCodes
http://hl7.org/fhir/ValueSet/benefit-network
From the FHIR Standard
Coverage.costToBeneficiary.unitexampleUnitTypeCodes
http://hl7.org/fhir/ValueSet/benefit-unit
From the FHIR Standard
Coverage.costToBeneficiary.termexampleBenefitTermCodes
http://hl7.org/fhir/ValueSet/benefit-term
From the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
From the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Mandatory: 0 element(2 nested mandatory elements)
Must-Support: 2 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Coverage.identifier
  • The element 1 is sliced based on the value of Coverage.class

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
.... identifier:VDASID SΣ 0..1 Identifier Business identifier(s) for this coverage
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:oid:1.2.40.0.10.1.4.3.9.1
..... assigner Σ 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... policyHolder Σ 0..1 Reference(HL7® AT Core Patient Profile | MOPED Hauptversicherter) Owner of the policy
... beneficiary Σ 1..1 Reference(HL7® AT Core Patient Profile) Plan beneficiary
... insurer Σ 0..1 Reference(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding
.... class:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc.
..... value Σ 1..1 Identifier Value associated with the type
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (required)
...... coding Σ 1..* Coding Code defined by a terminology system

Required Pattern: At least the following
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
..... value Σ 1..1 Identifier Value associated with the type
...... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
...... system Σ 0..1 uri The namespace for the identifier value
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.identifier:VDASID.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|5.0.0
From the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
From the FHIR Standard
Coverage.kindrequiredKind
http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0
From the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
From the FHIR Standard
Coverage.class:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
Coverage.class:Versichertenkategorien.value.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|5.0.0
From the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage Coverage
... Slices for identifier 0..* Identifier Business identifier(s) for this coverage
Slice: Unordered, Open by value:system
.... identifier:VDASID S 0..1 Identifier Business identifier(s) for this coverage
..... system 1..1 uri The namespace for the identifier value
Required Pattern: urn:oid:1.2.40.0.10.1.4.3.9.1
..... assigner 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... paymentBy
.... party 1..1 Reference(HL7® AT Core Organization Profile) Parties performing self-payment
... policyHolder 0..1 Reference(HL7® AT Core Patient Profile | MOPED Hauptversicherter) Owner of the policy
... insurer 0..1 Reference(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (required)
...... coding 1..* Coding Code defined by a terminology system
Required Pattern: At least the following
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
..... value
...... system 0..1 uri The namespace for the identifier value
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Coverage.class:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 0..* Identifier Business identifier(s) for this coverage
Slice: Unordered, Open by value:system
.... identifier:VDASID SΣ 0..1 Identifier Business identifier(s) for this coverage
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system Σ 1..1 uri The namespace for the identifier value
Required Pattern: urn:oid:1.2.40.0.10.1.4.3.9.1
..... value ΣC 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(HL7® AT Core Organization Profile) Organization that issued id (may be just text)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... kind Σ 1..1 code insurance | self-pay | other
Binding: Kind (required)
... paymentBy 0..* BackboneElement Self-pay parties and responsibility
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... party Σ 1..1 Reference(HL7® AT Core Organization Profile) Parties performing self-payment
.... responsibility Σ 0..1 string Party's responsibility
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelfPayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
... policyHolder Σ 0..1 Reference(HL7® AT Core Patient Profile | MOPED Hauptversicherter) Owner of the policy
... subscriber Σ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
... subscriberId Σ 0..* Identifier ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(HL7® AT Core Patient Profile) Plan beneficiary
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... insurer Σ 0..1 Reference(HL7® AT Core Organization Profile) Issuer of the policy
... Slices for class 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by value:type.coding
.... class:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc.
..... value Σ 1..1 Identifier Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:Versichertenkategorien S 0..1 BackboneElement Versichertenkategorien
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (required)
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 1..* Coding Code defined by a terminology system

Required Pattern: At least the following
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
..... value Σ 1..1 Identifier Value associated with the type
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
...... type Σ 0..1 CodeableConcept Description of identifier
Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
...... system Σ 0..1 uri The namespace for the identifier value
Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
...... value ΣC 0..1 string The value that is unique
Example General: 123456
...... period Σ 0..1 Period Time period when id is/was valid for use
...... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
..... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example)
.... network 0..1 CodeableConcept In or out of network
Binding: NetworkTypeCodes (example)
.... unit 0..1 CodeableConcept Individual or family
Binding: UnitTypeCodes (example)
.... term 0..1 CodeableConcept Annual or lifetime
Binding: BenefitTermCodes (example)
.... value[x] Σ 0..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details
... insurancePlan 0..1 Reference(InsurancePlan) Insurance plan details

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.languagerequiredAllLanguages
http://hl7.org/fhir/ValueSet/all-languages|5.0.0
From the FHIR Standard
Coverage.identifier:VDASID.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|5.0.0
From the FHIR Standard
Coverage.identifier:VDASID.typeextensibleIdentifierTypeCodes
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|5.0.0
From the FHIR Standard
Coverage.kindrequiredKind
http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0
From the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelfPayCodes
http://hl7.org/fhir/ValueSet/coverage-type
From the FHIR Standard
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
From the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
From the FHIR Standard
Coverage.class:Versichertenkategorien.typerequiredhttp://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
Coverage.class:Versichertenkategorien.value.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|5.0.0
From the FHIR Standard
Coverage.class:Versichertenkategorien.value.typeextensibleIdentifierTypeCodes
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
From the FHIR Standard
Coverage.costToBeneficiary.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
From the FHIR Standard
Coverage.costToBeneficiary.networkexampleNetworkTypeCodes
http://hl7.org/fhir/ValueSet/benefit-network
From the FHIR Standard
Coverage.costToBeneficiary.unitexampleUnitTypeCodes
http://hl7.org/fhir/ValueSet/benefit-unit
From the FHIR Standard
Coverage.costToBeneficiary.termexampleBenefitTermCodes
http://hl7.org/fhir/ValueSet/benefit-term
From the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
From the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Mandatory: 0 element(2 nested mandatory elements)
Must-Support: 2 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Coverage.identifier
  • The element 1 is sliced based on the value of Coverage.class

 

Other representations of profile: CSV, Excel, Schematron